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In the mid-1970s, Beer moved to mid-Wales where he lived in an almost austere style, developing strong interests in poetry and art. In the 1980s he established a second home on the west side of downtown Toronto and lived part of the year in both residences. He was a visiting professor at almost 30 universities and received an earned higher doctorate (DSc) from the University of Sunderland and honorary doctorates from the University of Leeds, the University of St. Gallen, and the University of Valladolid. He was president of the World Organization of Systems and Cybernetics. | https://en.wikipedia.org/wiki/Stafford_Beer |
In July 1994 Beer ran a residential course at the Falcondale Hotel in Lampeter. Nine sessions were recorded as a video learning resource, and are collectively known as the Falcondale collection. They are available online at the Data Repository of Liverpool John Moores University. The sessions covered art, science and philosophy as well as the practical application of cybernetics in society, government, community, management and business. Transcripts were made of the discussions and are also available from the same repository. | https://en.wikipedia.org/wiki/Stafford_Beer |
He was married twice, in 1947 to Cynthia Hannaway, and in 1968 to Sallie Steadman. His partner for the last twenty years of his life was Allenna Leonard, a fellow cybernetician. Beer had five sons and two daughters, one of whom is Vanilla Beer, an artist and essayist. | https://en.wikipedia.org/wiki/Stafford_Beer |
According to Jackson (2000) "Beer was the first to apply cybernetics to management, defining cybernetics as the science of effective organization". In the 1960s and early 1970s "Beer was a prolific writer and an influential practitioner" in management cybernetics. It was during that period that he developed the viable system model, to diagnose the faults in any existing organizational system. In that time Forrester invented systems dynamics, which "held out the promise that the behavior of whole systems could be represented and understood through modeling the dynamical feedback process going on within them". | https://en.wikipedia.org/wiki/Stafford_Beer |
During the administration of Salvador Allende in Chile, in the early 1970s, Beer was closely involved with a visionary project, Cybersyn, to apply his cybernetic theories in government. The project's ultimate goal was to create a network of computers and communications equipment that would support the management of the state-run sector of Chile's economy; at its core would be an operations room where government managers could view important information about economic processes in real time, formulate plans of action, and transmit advice and directives to managers at plants and enterprises in the field. However, consistent with cybernetic principles and the ideals of the Allende government, its designers aimed to preserve worker and lower-management autonomy instead of implementing a top-down system of centralised control. The system used a network of about 500 telex machines located at enterprises throughout the country and in government offices in Santiago, some of which were connected to a government-operated mainframe computer that would receive information on production operations, feed that information into economic modelling software, and report on variables (such as raw material supplies) that were outside normal parameters and might require attention. The project, implemented by a multidisciplinary group of both Chileans and foreigners, reached an advanced prototype stage, but was interrupted by the 1973 coup d'état. | https://en.wikipedia.org/wiki/Stafford_Beer |
The Viable System Model (VSM) is a model of the organisational structure of any viable or autonomous system. A viable system is any system organised in such a way as to meet the demands of surviving in the changing environment. One of the prime features of systems that survive is that they are adaptable. The VSM expresses a model for a viable system, which is an abstracted cybernetic description that is applicable to any organisation that is a viable system and capable of autonomy. | https://en.wikipedia.org/wiki/Stafford_Beer |
Syntegrity is a formal model presented by Beer in the 1990s and now is a registered trademark. It is a form of non-hierarchical problem solving that can be used in a small team of 10 to 42 people. It is a business consultation product that is licensed out to consulting firms. The term comes from the words "synergistic" and "tensegrity". | https://en.wikipedia.org/wiki/Stafford_Beer |
Stafford Beer coined and frequently used the term POSIWID (the purpose of a system is what it does) to refer to the commonly observed phenomenon that the de facto purpose of a system is often at odds with its official purpose. In an address to the University of Valladolid, Spain in October 2001, he said "According to the cybernetician the purpose of a system is what it does. This is a basic dictum. It stands for bald fact, which makes a better starting point in seeking understanding than the familiar attributions of good intention, prejudices about expectations, moral judgment or sheer ignorance of circumstances." This principle has been used to describe Social Machines as intelligent, for example in the case of "games with a purpose", and it provides a link between AI and cybernetics. | https://en.wikipedia.org/wiki/Stafford_Beer |
Beer received awards from the Royal Swedish Academy of Engineering Sciences in 1958, from the United Kingdom Systems Society, the Cybernetics Society, the American Society for Cybernetics, and the Operations Research Society of America. | https://en.wikipedia.org/wiki/Stafford_Beer |
Stafford Beer wrote several books and articles: 1959, Cybernetics and Management, English Universities Press. 1966, Decision and Control, Wiley, London. 1968, Management Science: The business use of operations research, Aldus Books, London, Doubleday, New York. 1972, Brain Of The Firm, Allen Lane, The Penguin Press, London, Herder and Herder, USA.Translated into German, Italian, Swedish, French and Russian. | https://en.wikipedia.org/wiki/Stafford_Beer |
1974, Designing Freedom, CBC Learning Systems, Toronto, 1974; and John Wiley, London and New York, 1975. Translated into Spanish and Japanese. 1975, Platform for Change, John Wiley, London and New York. | https://en.wikipedia.org/wiki/Stafford_Beer |
Reprinted with corrections 1978. 1977, Transit; Poems, CWRW Press, Wales. Limited Edition, Private Circulation. | https://en.wikipedia.org/wiki/Stafford_Beer |
1979, The Heart of Enterprise, John Wiley, London and New York. Reprinted with corrections 1988. 1981, Brain of the Firm; Second Edition (much extended), John Wiley, London and New York. | https://en.wikipedia.org/wiki/Stafford_Beer |
Reprinted 1986, 1988. Translated into Russian. | https://en.wikipedia.org/wiki/Stafford_Beer |
1983, Transit; Poems, Second edition (much extended). With audio cassettes: Transit – Selected Readings, and one Person Metagame; Mitchell Communications, Publisher, 2693 Route 845, Carters Point, NB, Canada, E5S 1S2. 1985, Diagnosing the System for Organizations; John Wiley, London and New York. | https://en.wikipedia.org/wiki/Stafford_Beer |
Translated into Italian and Japanese. Reprinted 1988, 1990, 1991. 1986, Pebbles to Computer: The Thread; (with Hans Blohm), Oxford University Press, Toronto. | https://en.wikipedia.org/wiki/Stafford_Beer |
1994, Beyond Dispute: The Invention of Team Syntegrity; John Wiley, Chichester.Audio1973, Stafford Beer. "Designing Freedom" The 1973 Massey Lectures RADIO CANADA INTERNATIONAL TRANSCRIPTION: E1121 "The Real Threat to all We Most Dear",E1122 "The Disregarded Tools of Modern Man",E1123, "A Liberty Machine in Prototype" E1124, "Science in The Service of Man" 1h 53:30. 1990, Stafford Beer, "Forty Years of Cybernetics", Gordon Hyde Memorial Lecture at the Cybernetics Society in London, January 1990 (audio file: 1hr 27mins).Video1990, Stafford Beer, The Intelligent Organization on YouTube Stafford Beer at Monterrey Tec, March 1990 illustrated by Javier LivasAbout Stafford Beer1994, Harnden, R and Leonard, A. | https://en.wikipedia.org/wiki/Stafford_Beer |
(Eds. ), How Many Grapes Went into the Wine: Stafford Beer on the Art and Science of Holisitic Management; John Wiley, Chichester. 2002, Rosemary Bechler and Rob Passmore, "Stafford Beer: the man who could have run the world", openDemocracy, 7 November 2002 2003, Whittaker, David, Stafford Beer: A Personal Memoir; (Includes an interview with Brian Eno) Wavestone Press, Charlbury 2004, "Ten pints of Beer: The rationale of Stafford Beer's cybernetic books (1959‐94)", Kybernetes, Vol. | https://en.wikipedia.org/wiki/Stafford_Beer |
33 No. 3/4, pp. 828–842. https://doi.org/10.1108/03684920410523724 2006, Jonathan Rosenhead, "IFORS' Operational Research Hall of Fame Stafford Beer", in International Transactions in Operational Research Vol 13, nr.6, pp. | https://en.wikipedia.org/wiki/Stafford_Beer |
577–581. 2009, Whittaker, David, (Ed.) Think Before you Think: Social Complexity and Knowledge of Knowing; (Selected writings of Stafford Beer with life chronology), Foreword by Brian Eno, Wavestone Press, Charlbury | https://en.wikipedia.org/wiki/Stafford_Beer |
Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs. Part D was enacted as part of the Medicare Modernization Act of 2003 and went into effect on January 1, 2006. Under the program, drug benefits are provided by private insurance plans that receive premiums from both enrollees and the government. Part D plans typically pay most of the cost for prescriptions filled by their enrollees. | https://en.wikipedia.org/wiki/Medicare_Part_D |
However, plans are later reimbursed for much of this cost through rebates paid by manufacturers and pharmacies.Part D enrollees cover a portion of their own drug expenses by paying cost-sharing. The amount of cost-sharing an enrollee pays depends on the retail cost of the filled drug, the rules of their plan, and whether they are eligible for additional Federal income-based subsidies. Prior to 2010, enrollees were required to pay 100% of their retail drug costs during the coverage gap phase, commonly referred to as the "doughnut hole.” Subsequent legislation, including the Affordable Care Act, “closed” the doughnut hole from the perspective of beneficiaries, largely through the creation of a manufacturer discount program. In 2019, about three-quarters of Medicare enrollees obtained drug coverage through Part D. Program expenditures were $102 billion, which accounted for 12% of Medicare spending. Through the Part D program, Medicare finances more than one-third of retail prescription drug spending in the United States. | https://en.wikipedia.org/wiki/Medicare_Part_D |
To enroll in Part D, Medicare beneficiaries must also be enrolled in either Part A or Part B. Beneficiaries can participate in Part D through a stand-alone prescription drug plan or through a Medicare Advantage plan that includes prescription drug benefits. Beneficiaries can enroll directly through the plan's sponsor or through an intermediary. Medicare beneficiaries who delay enrollment into Part D may be required to pay a late-enrollment penalty. In 2019, 47 million beneficiaries were enrolled in Part D, which represents three-quarters of Medicare beneficiaries. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Part D benefits are provided through private plans approved by the federal government. The number of offered plans varies geographically, but a typical enrollee will have dozens of options to choose from. Although plans are restricted by numerous program requirements, plans vary in many ways. Among other factors, enrollees often compare premiums, covered drugs, and cost-sharing policies when selecting a plan. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Medicare offers an interactive online tool that allows for comparison of coverage and costs for all plans in a geographic area. The tool lets users input their own list of medications and then calculates personalized projections of the enrollee's annual costs under each plan option. Plans are required to submit biweekly data updates that Medicare uses to keep this tool updated throughout the year. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Part D includes a statutorily defined "standard benefit" that is updated on an annual basis. All Part D sponsors must offer a plan that follows the standard benefit. The standard benefit is defined in terms of the benefit structure and without mandating the drugs that must be covered. For example, under the 2020 standard benefit, beneficiaries first pay a 100% coinsurance amount up to a $435 deductible. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Second, beneficiaries pay a 25% coinsurance amount up to an Out-of-Pocket Threshold of $6,350. In the final benefit phase, beneficiaries pay the greater of a 5% coinsurance amount or a nominal co-payment amount. These three benefit phases are referred to as the Deductible, Initial Coverage Limit, and the Catastrophic phase. | https://en.wikipedia.org/wiki/Medicare_Part_D |
The "Out-of-Pocket Threshold" is not a cap on out-of-pocket spending, as beneficiaries continue to accrue cost-sharing expenses in the Catastrophic phase. In 2020, beneficiaries would typically reach this threshold as their retail drug spending approached $10,000. When patients enter the Catastrophic phase, the amount they have paid in cost-sharing is typically much less than the Out-of-Pocket Threshold. | https://en.wikipedia.org/wiki/Medicare_Part_D |
This is because the standard benefit requires plans to include additional amounts, such as manufacturer discounts, when determining if the Out-of-Pocket Threshold has been met. Part D sponsors may also offer plans that differ from the standard benefit, provided that these alternative benefit structures do not result in higher average cost-sharing. In practice, most enrollees do not elect for standard benefit plans, instead opting for plans without deductibles and with tiered drug co-payments rather than coinsurance. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Enrollees must pay an additional premium amount to be enrolled in a plan with cost-sharing that is lower than the standard benefit, and this additional amount is not Federally-subsidized. Prior to 2010, the standard benefit included a Coverage Gap phase in which, after accruing significant spending, relatively-high cost enrollees were required to pay a 100% coinsurance amount until they entered the Catastrophic phase. This Coverage Gap phase is commonly referred to as "the Donut Hole." Beginning with the Affordable Care Act, cost-sharing in the Coverage Gap phase has been gradually reduced. Despite no longer triggering elevated cost-sharing, the Coverage Gap phase continues to exist for other administrative purposes. | https://en.wikipedia.org/wiki/Medicare_Part_D |
In 2020, the average monthly Part D premium across all plans was $27. Premiums for stand-alone PDPs are 3 times higher than premiums for MA-PDs, as Medicare Advantage plans often use federal rebates to reduce premiums for drug coverage. Enrollees typically pay their premiums directly to plans, though they may opt to have their premiums automatically deducted from their Social Security checks. Plans offer competitive premiums to attract enrollees. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Premiums must cover the cost of both plan liability and the reinsurance subsidy. From 2017 to 2020, despite rising per capita drug spending, premiums decreased by 16%. Plans have been able to lower premiums by negotiating larger rebates from manufacturers and pharmacies. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Between 2017 and 2020, the percentage of drug costs rebated back to plans increased from 22% to 28%. In addition, the standard benefit was changed in 2019 to increase mandatory manufacturer discounts in the Coverage Gap. Part D practices community rating, with all enrollees in a plan being assigned the same premium. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Enrollees do pay more in premiums if they enroll in higher-than-average-cost plans or in plans that offer enhanced benefits. Like in Part B, higher-income enrollees are required to pay an additional premium amount. Low-income enrollees may have their premium reduced or eliminated if they qualify for the low-income premium subsidy. | https://en.wikipedia.org/wiki/Medicare_Part_D |
For 2022, costs for stand-alone Part D plans in the 10 major U.S. markets ranged from a low of $6.90-per-month (Dallas and Houston) to as much as $160.20-per-month (San Francisco). A study by the American Association for Medicare Supplement Insurance reported the lowest and highest 2022 Medicare Plan D costs for the top-10 markets. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Beneficiaries with income below 150% of the poverty line are eligible for the low-income subsidy, which helps pay for premiums and cost-sharing. Depending on income-level and assets, some beneficiaries qualify for the full low-income subsidy, while others are eligible for a partial subsidy. All low-income subsidy enrollees still pay small copayment amounts. Low-income enrollees tend to have more chronic conditions than other enrollees. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Low-income subsidy enrollees represent about one-quarter of enrollment, but about half of the program's retail drug spending. Nearly 30% of Federal spending on Part D goes towards paying for the low-income subsidy.In addition to receiving premium and cost-sharing subsidies, certain program rules apply differently for low-income subsidy enrollees. Beneficiaries of the low-income subsidy are exempt from the Coverage Gap Manufacturer Discount Program. Low-income subsidy enrollees are also allowed to change plans more frequently than other enrollees. | https://en.wikipedia.org/wiki/Medicare_Part_D |
While CMS does not have an established formulary, Part D drug coverage excludes drugs not approved by the Food and Drug Administration, drugs not available by prescription for purchase in the United States, and drugs for which payments would be available under Part B.Part D coverage excludes drugs or classes of drugs that may be excluded from Medicaid coverage. These may include: Drugs used for anorexia, weight loss, or weight gain Drugs used to promote fertility Drugs used for erectile dysfunction Drugs used for cosmetic purposes (hair growth, etc.) Drugs used for the symptomatic relief of cough and colds Prescription vitamin and mineral products, except prenatal vitamins and fluoride preparations Drugs where the manufacturer requires as a condition of sale any associated tests or monitoring services to be purchased exclusively from that manufacturer or its designeeWhile these drugs are excluded from basic Part D coverage, drug plans can include them as a supplemental benefit, provided they otherwise meet the definition of a Part D drug. However plans that cover excluded drugs are not allowed to pass on those costs to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Part D plans are not required to pay for all covered Part D drugs. They establish their own formularies, or list of covered drugs for which they will make payment, as long as the formulary and benefit structure are not found by CMS to discourage enrollment by certain Medicare beneficiaries. Part D plans that follow the formulary classes and categories established by the United States Pharmacopoeia will pass the first discrimination test. Plans can change the drugs on their formulary during the course of the year with 60 days' notice to affected parties. | https://en.wikipedia.org/wiki/Medicare_Part_D |
The primary differences between the formularies of different Part D plans relate to the coverage of brand-name drugs. Typically, each Plan's formulary is organized into tiers, and each tier is associated with a set co-pay amount. Most formularies have between 3 and 5 tiers. | https://en.wikipedia.org/wiki/Medicare_Part_D |
The lower the tier, the lower the co-pay. For example, Tier 1 might include all of the Plan's preferred generic drugs, and each drug within this tier might have a co-pay of $5 to $10 per prescription. Tier 2 might include the Plan's preferred brand drugs with a co-pay of $40 to $50, while Tier 3 may be reserved for non-preferred brand drugs which are covered by the plan at a higher co-pay, perhaps $70 to $100. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Tiers 4 and higher typically contain specialty drugs, which have the highest co-pays because they are generally more expensive. By 2011 in the United States a growing number of Medicare Part D health insurance plans had added the specialty tier. : 1 | https://en.wikipedia.org/wiki/Medicare_Part_D |
Upon enactment in 1965, Medicare included coverage for physician-administered drugs, but not self-administered prescription drugs. While some earlier drafts of the Medicare legislation included an outpatient drug benefit, those provisions were dropped due to budgetary concerns. In response to criticism regarding this omission, President Lyndon Johnson ordered the formation of the Task Force on Prescription Drugs. The Task Force conducted a comprehensive review of the American prescription drug market and reported that many elderly Americans struggled to afford their medications.Despite the findings and recommendations of the Task Force, initial efforts to create a Medicare outpatient drug benefit were unsuccessful. | https://en.wikipedia.org/wiki/Medicare_Part_D |
In 1988, the Medicare Catastrophic Coverage Act temporarily expanded program benefits to include self-administered drugs. However, this legislation was repealed just one year later, partially due to concerns regarding premium increases. | https://en.wikipedia.org/wiki/Medicare_Part_D |
The 1993 Clinton Health Reform Plan also included an outpatient drug benefit, but that reform effort ultimately failed due to a lack of public support.In the decades following Medicare's passage, prescription drug spending grew and became increasingly financed through third-party payment. Following an era of modest growth, per capita drug spending began growing rapidly in the 1980s. This growth was partially spurred by the launch of many billion dollar “blockbuster drugs” like Lipitor, Celebrex, and Zoloft. | https://en.wikipedia.org/wiki/Medicare_Part_D |
At the time of Medicare's passage, more than 90% of drug spending was paid out-of-pocket. Over the following 35-years, third-party payment for prescription drugs became increasingly common. By the end of the century, less than one-third of drug spending was paid out-of-pocket. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Despite the absence of a Medicare drug benefit, about 70% of Medicare enrollees obtained drug coverage through other means, often through an employer or Medicaid.Medicare began offering subsidized outpatient drug coverage in the mid-2000s. In the 2000 presidential election, both the Democratic and Republican candidates campaigned on the promise of using the projected federal budget surplus to fund a new Medicare drug entitlement program. Following his electoral victory, President George W. Bush promoted a general vision of using private health plans to provide drug coverage to Medicare beneficiaries. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Rather than demand that the plan be budget neutral, President Bush supported up to $400 billion in new spending for the program. In 2003, President Bush signed the Medicare Modernization Act, which authorized the creation of the Medicare Part D program. The program was implemented in 2006. | https://en.wikipedia.org/wiki/Medicare_Part_D |
To keep the plan's cost projections below the $400 billion constraint set by leadership, policymakers devised the infamous “donut hole.” After exceeding a modest deductible, beneficiaries would pay 25% cost-sharing for covered drugs. However, once their spending reached an “initial coverage limit,” originally set at $2,250, their cost-sharing would return to 100% of the drug's cost. This loss in coverage would continue until the patient surpassed an out-of-pocket threshold Beneficiaries were often confused by this complicated design, and research consistently found that this coverage gap reduced medication adherence. The Affordable Care Act and subsequent legislation phased-out the coverage gap from the perspective of beneficiaries. As of 2020, beneficiary cost-sharing on covered drugs never exceeds 25% of the drug's cost after an enrollee meets their deductible. | https://en.wikipedia.org/wiki/Medicare_Part_D |
In 2019, total drug spending for Medicare Part D beneficiaries was about 180 billion dollars. One-third of this amount, about 120 billion dollars, was paid by prescription drug plans. This plan liability amount was partially offset by about 50 billion dollars in discounts, mostly in the form of manufacturer and pharmacy rebates. This implied a net plan liability (i.e. net of discounts) of roughly 70 billion dollars. | https://en.wikipedia.org/wiki/Medicare_Part_D |
To finance this cost, plans received roughly 50 billion in federal reinsurance subsidies, 10 billion in federal direct subsidies, and 10 billion in enrollee premiums.In addition to the 60 billion dollars paid in federal insurance subsidies, the federal government also paid about 30 billion dollars in cost-sharing subsidies for low-income enrollees. The federal government also collected roughly 20 billion in offsetting receipts. These offsets included both state payments made on behalf of Medicare beneficiaries who also qualify for full Medicaid benefits and additional premiums paid by high-income enrollees. After accounting for these offsets, the net federal cost of Part D was about 70 billion dollars. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Plan and Health Care Provider goal alignment: PDP's and MA's are rewarded for focusing on low-cost drugs to all beneficiaries, while providers are rewarded for quality of care – sometimes involving expensive technologies. Conflicting goals: Plans are required to have a tiered exemptions process for beneficiaries to get a higher-tier drug at a lower cost, but plans must grant medically necessary exceptions. However, the rule denies beneficiaries the right to request a tiering exception for certain high-cost drugs. Lack of standardization: Because each plan can design their formulary and tier levels, drugs appearing on Tier 2 in one plan may be on Tier 3 in another plan. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Co-pays may vary across plans. Some plans have no deductibles and the coinsurance for the most expensive drugs varies widely. Some plans may insist on step therapy, which means that the patient must use generics first before the company will pay for higher-priced drugs. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Patients can appeal and insurers are required to respond within a short timeframe, so as to not further the burden on the patient. Standards for electronic prescribing for Medicare Part D conflict with regulations in many U.S. states. | https://en.wikipedia.org/wiki/Medicare_Part_D |
A 2008 study found that the percentage of Medicare beneficiaries who reported forgoing medications due to cost dropped with Part D, from 15.2% in 2004 and 14.1% in 2005 to 11.5% in 2006. The percentage who reported skipping other basic necessities to pay for drugs also dropped, from 10.6% in 2004 and 11.1% in 2005 to 7.6% in 2006. The very sickest beneficiaries reported no reduction, but fewer reported forgoing other necessities to pay for medicine.A parallel study found that Part D beneficiaries skip doses or switch to cheaper drugs and that many do not understand the program. Another study found that Part D resulted in modest increases in average drug utilization and decreases in average out-of-pocket expenditures. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Further studies by the same group of researchers found that the net impact among beneficiaries was a decrease in the use of generic drugs.A further study concludes that although a substantial reduction in out-of-pocket costs and a moderate increase in utilization among Medicare beneficiaries during the first year after Part D, there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D during its first year of implementation. It was also found that there were no significant changes in trends in the dual eligibles' out-of-pocket expenditures, total monthly expenditures, pill-days, or total number of prescriptions due to Part D.A 2020 study found that Medicare Part D led to a sharp reduction in the number of people over the age of 65 who worked full-time. The authors say that this is evidence that before the change, people avoided retiring in order to maintain employer-based health insurance. | https://en.wikipedia.org/wiki/Medicare_Part_D |
The federal government is not permitted to negotiate Part D drug prices with drug companies, as federal agencies do in other programs. The Department of Veterans Affairs, which is allowed to negotiate drug prices and establish a formulary, has been estimated to pay between 40% and 58% less for drugs, on average, than Part D. On the other hand, the VA only covers about half the brands that a typical Part D plan covers. Part of the issue is that Medicare does not pay for Part D drugs, and so has no actual leverage. Part D drug providers are using the private insurer leverage, which is generally a larger block of consumers than the 40 million or so actually using Medicare parts A and B for medical care. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Although generic versions of drugs are now available, plans offered by three of the five insurers currently exclude some or all of these drugs from their formularies. ... Further, prices for the generic versions are not substantially lower than their brand-name equivalents. The lowest price for simvastatin (generic Zocor) 20 mg is 706 percent more expensive than the VA price for brand-name Zocor. | https://en.wikipedia.org/wiki/Medicare_Part_D |
The lowest price for sertraline HCl (generic Zoloft) is 47 percent more expensive than the VA price for brand-name Zoloft." Estimating how much money could be saved if Medicare had been allowed to negotiate drug prices, economist Dean Baker gives a "most conservative high-cost scenario" of $332 billion between 2006 and 2013 (approximately $50 billion a year). | https://en.wikipedia.org/wiki/Medicare_Part_D |
Economist Joseph Stiglitz in his book entitled The Price of Inequality estimated a "middle-cost scenario" of $563 billion in savings "for the same budget window". : 48 Former Congressman Billy Tauzin, R–La., who steered the bill through the House, retired soon after and took a $2 million a year job as president of Pharmaceutical Research and Manufacturers of America (PhRMA), the main industry lobbying group. Medicare boss Thomas Scully, who threatened to fire Medicare Chief Actuary Richard Foster if he reported how much the bill would actually cost, was negotiating for a new job as a pharmaceutical lobbyist as the bill was working through Congress. | https://en.wikipedia.org/wiki/Medicare_Part_D |
14 congressional aides quit their jobs to work for related lobbies immediately after the bill's passage.In response, free-market think tank Manhattan Institute issued a report by professor Frank Lichtenberg that said the VA National Formulary excludes many new drugs. Only 38% of drugs approved in the 1990s and 19% of the drugs approved since 2000 were on the formulary.In 2012, the plan required Medicare beneficiaries whose total drug costs reach $2,930 to pay 100% of prescription costs until $4,700 is spent out of pocket. (The actual threshold amounts change year-to-year and plan-by-plan, and many plans offered limited coverage during this phase.) While this coverage gap does not affect the majority of program participants, about 25% of beneficiaries enrolled in standard plans find themselves in this gap.As a candidate, Barack Obama proposed "closing the 'doughnut hole'" and subsequently proposed a plan to reduce costs for recipients from 100% to 50% of these expenses. The cost of the plan would be borne by drug manufacturers for name-brand drugs and by the government for generics. | https://en.wikipedia.org/wiki/Medicare_Part_D |
Seed-based d mapping (formerly Signed differential mapping) or SDM is a statistical technique created by Joaquim Radua for meta-analyzing studies on differences in brain activity or structure which used neuroimaging techniques such as fMRI, VBM, DTI or PET. It may also refer to a specific piece of software created by the SDM Project to carry out such meta-analyses. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
SDM adopted and combined various positive features from previous methods, such as ALE or MKDA, and introduced a series of improvements and novel features. One of the new features, introduced to avoid positive and negative findings in the same voxel as seen in previous methods, was the representation of both positive differences and negative differences in the same map, thus obtaining a signed differential map (SDM). Another relevant feature, introduced in version 2.11, was the use of effect sizes (leading to effect-size SDM or 'ES-SDM'), which allows combination of reported peak coordinates with statistical parametric maps, thus allowing more exhaustive and accurate meta-analyses.The method has three steps. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
First, coordinates of cluster peaks (e.g. the voxels where the differences between patients and healthy controls were highest), and statistical maps if available, are selected according to SDM inclusion criteria. Second, coordinates are used to recreate statistical maps, and effect-sizes maps and their variances are derived from t-statistics (or equivalently from p-values or z-scores). Finally, individual study maps are meta-analyzed using different tests to complement the main outcome with sensitivity and heterogeneity analyses. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
It is not uncommon in neuroimaging studies that some regions (e.g. a priori regions of interest) are more liberally thresholded than the rest of the brain. However, a meta-analysis of studies with such intra-study regional differences in thresholds would be biased towards these regions, as they are more likely to be reported just because authors apply more liberal thresholds in them. In order to overcome this issue SDM introduced a criterion in the selection of the coordinates: while different studies may employ different thresholds, you should ensure that the same threshold throughout the whole brain was used within each included study. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
After conversion of statistical parametric maps and peak coordinates to Talairach space, an SDM map is created for each study within a specific gray or white matter template. Pre-processing of statistical parametric maps is straightforward, while pre-processing of reported peak coordinates requires recreating the clusters of difference by means of an un-normalized Gaussian Kernel, so that voxels closer to the peak coordinate have higher values. A rather large full-width at half-maximum (FWHM) of 20mm is used to account for different sources of spatial error, e.g. coregistration mismatch in the studies, the size of the cluster or the location of the peak within the cluster. Within a study, values obtained by close Gaussian kernels are summed, though values are combined by square-distance-weighted averaging. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
SDM provides several different statistical analyses in order to complement the main outcome with sensitivity and heterogeneity analyses. The main statistical analysis is the mean analysis, which consists in calculating the mean of the voxel values in the different studies. This mean is weighted by the inverse of the variance and accounts for inter-study heterogeneity (QH maps). Subgroup analyses are mean analyses applied to groups of studies to allow the study of heterogeneity. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
Linear model analyses (e.g. meta-regression) are a generalization of the mean analysis to allow comparisons between groups and the study of possible confounds. A low variability of the regressor is critical in meta-regressions, so they are recommended to be understood as exploratory and to be more conservatively thresholded. Jack-knife analysis consists in repeating a test as many times as studies have been included, discarding one different study each time, i.e. removing one study and repeating the analyses, then putting that study back and removing another study and repeating the analysis, and so on. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
The idea is that if a significant brain region remains significant in all or most of the combinations of studies it can be concluded that this finding is highly replicable.The statistical significance of the analyses is checked by standard randomization tests. It is recommended to use uncorrected p-values = 0.005, as this significance has been found in this method to be approximately equivalent to a corrected p-value = 0.05. A false discovery rate (FDR) = 0.05 has been found in this method to be too conservative. Values in a Talairach label or coordinate can also be extracted for further processing or graphical presentation. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
SDM is software written by the SDM project to aid the meta-analysis of voxel-based neuroimaging data. It is distributed as freeware including a graphical interface and a menu/command-line console. It can also be integrated as an SPM extension. | https://en.wikipedia.org/wiki/Seed-based_d_mapping |
Multi-age classrooms or composite classes are classrooms with students from more than one grade level. They are created because of a pedagogical choice of a school or school district. They are different from split classes which are formed when there are too many students for one class – but not enough to form two classes of the same grade level. Composite classes are more common in smaller schools; an extreme form is the one-room school. Studies of the performance of students in composite classes shows their academic performance is not substantially different from those in single-grade classrooms; instead, outcomes tend to be a function of the teacher's performance. | https://en.wikipedia.org/wiki/Multi-age_classroom |
Multi-age schooling originated in one-room schoolhouses during the 19th century. It became less common in the 20th century with the rise of mainstream schooling. However, multi-age schooling had a resurgence in the 1960s. Approximately one third of all classes across the world are multigrade classes. | https://en.wikipedia.org/wiki/Multi-age_classroom |
“In Canada, more than 20 percent of students are registered in split classes, and that number is growing. Around the world, split classes are also a growing phenomenon in countries as diverse as Australia, France, Switzerland and the Netherlands.” (Kelly, 2015) The reasoning behind multi-age classrooms is distinct from that of split classes. While split classes are created when there are not enough students to form two separate single age classes, multi-age classes are intentionally formed to create a mixed age, diverse learning environment. | https://en.wikipedia.org/wiki/Multi-age_classroom |
This is an important distinction, as the reason for creating a split class or multi-age class will dictate what kinds of teaching strategies and pedagogy is applied in the classroom, which will in turn impact student outcomes. For a given number of students, composite classes allow greater administrative flexibility in allocating students to classes. | https://en.wikipedia.org/wiki/Multi-age_classroom |
This allows gender balancing, matching of student needs to teaching expertise, and balancing class sizes. By allocating children to classes according to specific learning needs, it is possible to arrange classes with narrower ranges of abilities. Schools composed exclusively of composite classes are increasingly common in Australian primary school education; they are not uncommon in New Zealand.Composite classes often meet resistance, with parents often believing that their child is disadvantaged by being in one. This perception is often regardless of whether their child would be in the younger or older cohort.Advocates of multi-age classrooms point to the lack of age stratification in workplaces, families or other social environments as a reason to create a similar environment in the classroom. | https://en.wikipedia.org/wiki/Multi-age_classroom |
Social benefits often cited are: Older children in a composite class get more leadership opportunities and frequently build self-esteem as a sort or role model to the younger class mates. Younger children aspire to do work like the older children in the class. The ability for a child to be educated by the one teacher for two years, creating a stronger relationship.Educational benefits often cited are: Because literacy and numeracy are taught in ability groups, teachers need heightened awareness of individual student's capabilities – they must think of children as individuals. The techniques of classroom teaching and of individual teaching can be still applied. | https://en.wikipedia.org/wiki/Multi-age_classroom |
Learning by teaching occurs when students at different stages of learning can help each other with their work; children resolve differences in understanding of material.Composite classes provide a range of levels of work, so the needs of both talented children and slower learners can be catered for, while providing a supportive environment for both.At any one time, both composite and single-level classes have groups of students at a variety of levels. This is part of the normal delivery of the curriculum. | https://en.wikipedia.org/wiki/Multi-age_classroom |
Education expectations are set at curriculum levels which span across two years; for example, see the Victorian Essential Learning Standards. Contemporary teaching and learning materials are developed for multi-age classes. By using them, teachers can introduce core concepts to the whole classroom, and then differentiate instruction for the range of learners in the classroom. | https://en.wikipedia.org/wiki/Multi-age_classroom |
The students will be of a greater range of size, age and maturity which can have both positive and negative implications particularly in class sporting activities and playground interaction. | https://en.wikipedia.org/wiki/Multi-age_classroom |
Opponents of multi-age classrooms argue that most parents would rather have their children in a single grade-level classroom instead of a multi-grade level classroom. They also argue that students in the upper grade level of a composite class learn the same material that they were taught in the lower grade level. In contrast, talented children may find the work too easy since they have already learned it. However, slower learners, or students who failed the curriculum or a certain subject may have been placed in a composite class to catch up to the curriculum or become more proficient in a subject. | https://en.wikipedia.org/wiki/Multi-age_classroom |
James R. Markusen is an American economist, academic, and author. He is Distinguished Professor (emeritus) at the University of Colorado, Boulder.Markusen is known for his works using analytical theory, numerical simulation, and empirical estimation. Among his authored works are publications in the American Economic Review, the Quarterly Journal of Economics, and the Journal of International Economics, as well as books such as Multinational Firms and the Theory of International Trade.Markusen is a Research Associate at the National Bureau of Economic Research, a Research Fellow at the Centre for Economic Policy Research, London, and an affiliate at CESifo, Munich. He has served as the co-editor of Journal of International Economics. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen completed his B.A. in Economics in 1970 from Boston College. Later in 1973, he obtained a PHD in Economics under the supervision of James E. Anderson and John G. Riley from the same institution. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen began his academic career in 1972 by joining the University of Western Ontario as a professor of economics and served until 1990. In 1990, he joined the University of Colorado, where he held multiple appointments including serving as a university Distinguished Professor, Stanford Calderwood Professor of Economics from 2000 to 2003 and continues to hold the position of Distinguished Professor emeritus at the same institution. From 2008 to 2010, he served as a professor of economics at University College Dublin. In 2017, he became an Adjunct Professor at Shandong University, a position he held until 2020.Between 1999 and 2004, he worked as a research associate at the Centre for Economics and Business Research, Copenhagen. | https://en.wikipedia.org/wiki/James_Markusen |
Concurrently, he served as an Economic Policy Panelist at the Centre for Economic Policy Research London in 2000 and 2001. Since 1996, he has been a Research Fellow at the Centre for Economic Policy Research, London, and also held the position of research associate at the Institute for International Integration Studies at Trinity College Dublin since from 2003 to 2004. Additionally, he has been a research associate at the National Bureau of Economic Research since 1990. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen's research has focused on analytical theory, empirical estimation, and numerical simulation. He has authored publications spanning the areas of multinationals, international trade, modeling and simulation, and microeconomics including books, book chapters, and articles in peer-reviewed journals. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen's international trade and economics research has contributed to the identification of factors that influence trade patterns. His early research investigated how multinational firms can strategically manage their valuable knowledge capital when expanding abroad, considering options like exporting, licensing, and subsidiary acquisition, while analyzing the factors influencing these choices and their impact on international specialization patterns. Focusing his research efforts on the complex decision-making process of whether and how various issues should be combined in international trade negotiations, he along with Ignatius J. Horstmann proposed a formal framework using a two-issue bargaining model, highlighting the potential benefits and trade-offs of both separate negotiations and linked negotiations. | https://en.wikipedia.org/wiki/James_Markusen |
His 2007 synthetic analysis with Anthony J. Venables explored how countries' participation in the global economy, considering factors like trade costs and trade fragmentation, impacts their production specialization, trade volume, and welfare levels, revealing that while fragmentation generally increases trade and welfare, some countries may experience negative effects. In related research, he used gains-from-trade theory to analyze the effects of trade expansion through fragmentation and offshoring of new goods and intermediates and highlighted how changing trade dynamics in fragmented economies can affect the conditions under which countries benefit from liberalization. More recently in 2014, his study proposed an alternative approach to international trade analysis by examining the relationship between the characteristics of goods and services in production and consumer preferences and established a strong correlation between skilled-labor intensity and income elasticity. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen in his research has extensively explored the role of multinationals in the international economy. Beginning with a 1984 article, Markusen changed the focus of multinational-firm research from a macroeconomic capital market orientation to one emphasizing location and production, thereby integrating multinationals with microeconomic trade theory. His early and subsequent work advanced the view that multinationals are primarily "horizontal" firms in which affiliates roughly replicate the firms' core activities abroad to serve local markets, rather than "vertical" firms in which affiliates are links in production chains.In his 1995 study, Markusen examined real-world data concerning multinational corporations and developed a theory on the idea of knowledge capital as a transferable element to distant production units, elucidating the reasons that drive international production. In related research, he suggested that firms can geographically separate knowledge-based activities from production, resulting in vertical and horizontal multinational corporations, with skilled-labor intensity driving the former and joint-input characteristics driving the latter. | https://en.wikipedia.org/wiki/James_Markusen |
While examining the different theories of multinational firms, he developed his hybrid Knowledge Capital Model, which combined elements of both vertical and horizontal models, and provided a representation of the determinants of foreign direct investment. In his assessment of a firm's mode of operation, his work concluded that the choice between direct market entry and using a local agent depends on factors like market size and the potential for asset dissipation through agent opportunistic behavior, lower profits, with direct investment being favored in larger markets with lower downside profit-risk.Focusing on the role of multinational firms in international economics, Markusen's book titled Multinational Firms and the Theory of International Trade provided insights into the interplay among scale economies, expenses related to trade, factor endowments, and instances of imperfect competition. A. Kokko, while reviewing the book commended Markusen's efforts in presenting a consistent general-equilibrium-theory of Multinational Firms and said "Markusen has succeeded on all three counts, although it may be somewhat of an exaggeration to say that it has been done easily: it has taken some 20 years and plenty of innovative methodology to reach a stage where the work can be summarized in one book." | https://en.wikipedia.org/wiki/James_Markusen |
Concentrating his research efforts on investment liberalization and its impact on the location of firms, his study bridged the gap between the industrial organization approach and general-equilibrium trade theory, providing an understanding of international trade. Furthermore, his work highlighted the limitations of existing research in the field of multinational enterprises and emphasized the need for more formal and comprehensive theoretical frameworks that can effectively link assumptions with conclusions. Moreover, in his 2021 book titled Broadening Trade Theory: Incorporating Market Realities Into Traditional Models, he provided a view of trade theory by exploring the roles of multinational firms, demand-side dynamics, and various policy implications that have been less explored in mainstream trade economics. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen's modeling and simulation research has resulted in the development of new theories and models of international trade. In his early research, he developed a theoretical model for multinational enterprises based on shared input efficiencies, and analyzed the trade-offs between technical efficiency gains and increased market power, along with broader welfare implications for different countries. Later in 1995, he presented a model that challenged some prevailing assumptions from the 'new trade theory' and offered an alternative perspective on the dynamics of international economic relationships. In 2000, he along with Anthony J. Venables developed a model of international trade with positive trade costs and endogenous multinational firms, showing how trade costs impact trade patterns, and incentivize factor mobility and agglomeration. | https://en.wikipedia.org/wiki/James_Markusen |
His 2001 study with Mattias Ganslandt introduced modeling approaches for representing international trade standards and technical regulations and advocated for their incorporation into an applied general-equilibrium framework using authentic data. Focusing his research efforts on modeling the offshoring of white-collar services, his work proposed using existing trade theory as a foundation, while adapting and combining relevant concepts into simple models, to analyze the offshoring of white-collar services and its effects in response to technological and institutional changes. Moreover, in 2009, he analyzed the interaction between optimal trade policy and firm pricing using a generalized model incorporating product differentiation and revealed that when similarity exists in substitution elasticities at national and sub-national levels, the capacity of small economies to enhance terms of trade via trade imbalances is constrained. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen's regional economics research has investigated how factors such as infrastructure and education, impact economic development across different regions. In collaboration with Nancy Olewiler and others, he presented a two-region economic model in which a polluting firm's market presence and environmental policies were influenced by the level of disutility from pollution, leading to either competition through higher environmental standards or through undercutting pollution tax rates between regions. In his analysis of domestic-content rules in regional trade agreements, his study suggested that domestic-content rules in regional trade agreements, especially in industries with foreign multinationals heavily reliant on imported inputs, can lead to anti-competitive effects, potentially decreasing industry output and shifting economic rents to domestic firms. While examining the impact of Free Trade Area of the Americas (FTAA) on investment strategies of multinational firms outside the region, his work highlighted that while FTAA integration offers opportunities for third-country firms, the competitive advantages enjoyed by insider firms from the Americas could potentially lead to less substantial benefits for the former. More recently in 2022, he investigated changes in employment concentration and specialization across industries and occupations in United States regions and proposed a model where regional specialization is influenced by function-specific productivity differences. The research also demonstrated that decreasing costs of sourcing functions from different regions leads to reduced sector concentration and regional specialization but increased function concentration and specialization. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen's microeconomics research has identified microeconomic factors driving external economies, analyzed their impact on production and welfare using a general-equilibrium model, and explored how resulting industry production functions relate to established trade and growth theories. Moreover, he developed a unified model to analyze the impact of foreign-owned firms on domestic wages and suggested that being employed by a highly productive company, whether from one's own country or from abroad, leads to favorable outcomes for personal productivity. | https://en.wikipedia.org/wiki/James_Markusen |
1997 – Boulder Faculty Assembly Research Excellence Award, University of Colorado 2001 – Jagdish Bhagwati Award, Journal of International Economics 2003 – Stanford Calderwood Teaching Excellence Award, Calderwood Charitable Foundation 2019 – Doctor of Philosophy, Tuebingen University | https://en.wikipedia.org/wiki/James_Markusen |
Speculation and Monopoly in Urban Development (1997) ISBN 9780802033482 Multinational Firms and the Theory of International Trade (2002) ISBN 9780262134163 Broadening Trade Theory: incorporating market realities into traditional models (2021) ISBN 9789811222955 | https://en.wikipedia.org/wiki/James_Markusen |
Markusen, J. R. (1984). Multinationals, multi-plant economies, and the gains from trade. Journal of international economics, 16(3–4), 205–226. | https://en.wikipedia.org/wiki/James_Markusen |
Markusen, J. R. (1995). The boundaries of multinational enterprises and the theory of international trade. | https://en.wikipedia.org/wiki/James_Markusen |
Journal of Economic perspectives, 9(2), 169–189. Markusen, J. R., & Venables, A. J. (1998). | https://en.wikipedia.org/wiki/James_Markusen |
Multinational firms and the new trade theory. Journal of international economics, 46(2), 183–203. Markusen, J. R., & Venables, A. J. | https://en.wikipedia.org/wiki/James_Markusen |
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